Monday, October 28, 2013

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This week touches base this week on a couple of medical items floating through the sports world.

Josh Freeman, the concussed Minnesota Viking, didn’t get much love from NBC analyst Rodney Harrison, who questioned the diagnosis, the recovery time and the general will to play of the injured quarterback. Freeman. Harrison tweeted: “I played safety at a high level for a long time and I was bangin’ and I never missed a game because of a concussion so it just seems like an excuse to me.”

As we learn more about traumatic brain injury, its symptoms and healing, Harrison’s stance is just wrong in too many ways. The first lesson to learn is that the diagnosis of concussion is often missed because the player may not recognize that the brain has been shaken. Symptoms can be delayed by hours or days and may be very subtle. Symptoms may include difficulty with concentration, studying and processing information, sleep disturbance, headache and difficulty tolerating sound and light. School performance may suffer and it may take months for grades to recover. The second lesson is that there is no test to confirm that a concussion has occurred and there is no test that can say that the brain has healed completely.

Harrison may be trying to be old school where a player would rub some dirt on an injury and get back on the field no matter what. Instead he fails to appreciate that the decision to keep Freeman on the sideline was made by the team medical staff and it is an important message that the pros send to young players. High school players share the same drive to compete and on any given Friday night, trainers can be seen taking away a concussed player’s helmet to underscore the importance that their brain is more important than any game.

Every little leaguer dreams of playing in the World Series. How disappointing for Shane Victorino to be so close and yet have to sit on the bench because of low back pain. The muscle strain that has bothered him most of the year flared to the point that he could not perform and he joins the millions of Americans who suffer with low back pain. At least 40% of people will suffer an episode of back pain in their lifetime. Too often, the cause is never found and in fact, it is rarely sought. Most low back pain is due to mechanical abnormalities in the muscles and joints and resolves with time and supportive care. Arthritis of the spine, degeneration or rupture of disks and osteoporosis are causes that increase with age. Infections and tumors are rare. Diagnosis and treatment often depend upon history and physical exam.

While pro athletes are routinely Xrayed, CTed and MRIed, regular patients tend to be treated with high touch instead of high tech. Initial treatment with rest, ice and anti-inflammatory medications can be supplemented by exercise, physical therapy and chiropractic care. The lesson to be learned from the athlete is that once a back is injured, the next occurrence is to be feared and preventive measures are key. Core strength training, balancing the muscles of the abdominal wall with those of the back, is supplemented with stretching and flexibility. Perhaps most important is paying attention to back symptoms and learning when it is completely healed and ready to return to work or play. Mr. VIctorino has struggled with back issues all year and his decision to play through the pain put his World Series dream at risk.

Regardless of what the NFL says about Denver Bronco’s Peyton Manning high ankle sprain, this injury does not affect the ankle. Instead, it is an injury to the syndesmosis or interosseous ligaments that attach the tibia and fibula in the lower shin. (inter=between + osseous=bone). The damage occurs when there is a twisting injury to the leg on a planted foot with the damage occurring well above the ankle joint. While the swelling and tenderness tends to be higher than the ankle joint, there can be associated ankle ligament damage that may confuse the diagnosis.

Ankle sprains are very common, presenting most often with swelling and tenderness on the lateral or outer side of the ankle joint. They tend to heal with rest, ice, compression and elevation. Syndesmotic injuries may heal with that care as well, but there is the risk of instability surgery may be required to drill a screw that keeps the tibia and fibula tethered together. These injuries can take months to heal and rehabilitate and are definitely not the rolled ankle from the Y pickup basketball game.

This is the same Peyton who survived four neck surgeries and has returned to all-star form. Perhaps the NFL is right and his is just a sprain.